Pineal Region Tumors. Diagnosis and Treatment Options

Pineal Region Tumors. Diagnosis and Treatment Options

Progress in Neurological Surgery Vol. 23 Series Editor L. Dade Lunsford Pittsburgh, Pa.

Pineal Region Tumors Diagnosis and Treatment Options Volume Editors Tatsuya Kobayashi Nagoya L. Dade Lunsford Pittsburgh, Pa. 58 figures, 19 in color, and 28 tables, 2009 Basel Freiburg Paris London New York Bangalore Bangkok Shanghai Singapore Tokyo Sydney

Tatsuya Kobayashi, MD, PhD Nagoya Radiosurgery Center Nagoya Kyoritsu Hospital Nagoya, Japan L. Dade Lunsford, MD, FACS Lars Leksell and Distinguished Professor of Neurological Surgery The University of Pittsburgh Pittsburgh, Pa., USA Library of Congress Cataloging-in-Publication Data Pineal region tumors: diagnosis and treatment options / volume editors, Tatsuya Kobayashi, L. Dade Lunsford. p. ; cm. (Progress in neurological surgery, ISSN 0079-6492 ; v. 23) Includes bibliographical references and indexes. ISBN 978-3-8055-9077-8 (hardcover: alk. paper) 1. Pineal gland Tumors. 2. Pineal gland Tumors Surgery. I. Kobayashi, Tatsuya, 1938- II. Lunsford, L. Dade. [DNLM: 1. Pinealoma therapy. 2. Brain Neoplasms therapy. 3. Pineal Gland physiopathology. W1 PR673 v. 23 2009 / WK 350 P649245 2009] RC280. P5P56 2009 616. 99 447 dc22 2008055657 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and PubMed/MEDLINE. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2009 by S. Karger AG, P.O. Box, CH 4009 Basel (Switzerland) www.karger.com Printed in Switzerland on acid-free and non-aging paper (ISO 9706) by Reinhardt Druck, Basel ISSN 0079 6492 ISBN 978 3 8055 9077 8 e-isbn 978 3 8055 9078 5

Contents VII Series Editor s Note Lunsford, L.D. (Pittsburgh, Pa.) IX Preface Kobayashi, T. (Nagoya) Introduction 1 Statistical Analysis of Pineal Tumors Based on the Data of Brain Tumor Registry of Japan Shibui, S.; Nomura, K. (Tokyo) Tumors of Pineal Cell Origin 12 Pathology of Pineal Parenchymal Tumors Sato, K.; Kubota, T. (Fukui) 26 Occipital Transtentorial Approach and Combined Treatments for Pineal Parenchymal Tumors Tsumanuma, I. (Niigata); Tanaka, R. (Tsubame); Fujii, Y. (Niigata) 44 Role of Stereotactic Radiosurgery in the Management of Pineal Parenchymal Tumors Kano, H.; Niranjan, A.; Kondziolka, D.; Flickinger, J.C.; Lunsford, L.D. (Pittsburgh, Pa.) Tumors of Germ Cell Origin 59 Pathology of Intracranial Germ Cell Tumors Sato, K.; Takeuchi, H.; Kubota, T. (Fukui) 76 Pineal Germ Cell Tumors Matsutani, M. (Saitama) 86 Strategy of Combined Treatment of Germ Cell Tumors Sawamura, Y. (Sapporo/Tokyo) 96 Radiation Therapy for Intracranial Germ Cell Tumors Aoyama, H. (Sapporo) 106 Stereotactic Radiosurgery for Pineal and Related Tumors Mori, Y.; Kobayashi, T. (Nagoya); Hasegawa, T.; Yoshida, K.; Kida, Y. (Komaki) V

119 Management of Central Nervous System Germinoma: Proposal for a Modern Strategy Shibamoto, Y. (Nagoya) 130 Quality of Life of Extremely Long-Time Germinoma Survivors Mainly Treated with Radiotherapy Sugiyama, K.; Yamasaki, F.; Kurisu, K.; Kenjo, M. (Hiroshima) 140 Author Index 141 Subject Index VI Contents

Series Editor s Note Despite their relative rarity, tumors of the pineal region have remained of great interest to neurosurgeons, radiation, and medical oncologists. At many international meetings, controversy reigns as the merits and risks of various treatment strategies are debated. In Asia, the incidence of germ cell tumors seems much greater than the incidence seen in North American or European populations. Classification systems are occasionally confusing as tumors of the pineal region may arise from cells within the pineal parenchyma, from germ cell origin, from adjacent structures including the dorsal midbrain, from other midline structures, or from the tentorium. In this volume, the authors report various diagnostic and treatment strategies for tumors of the pineal region, emphasizing multimodality management in many patients. For some patients of the pineal region, the evaluation often needs to include pertinent serum or cerebrospinal fluid markers, which may be elevated in nongerminomatous germ cell tumors (a rather oxymoronic term developed by pathologists to confuse clinicians, I suppose). High-resolution magnetic resonance imaging is critical to assess the tumor and to follow the response to treatment. A variety of treatment modalities as well as various surgical approaches are discussed in this volume. We have asked many Asian colleagues to present their experience in this volume, in part because of the more frequent management of these tumors in the Asian population. I am sure that their findings are applicable to all patients and all centers that diagnose pineal region tumors. L. Dade Lunsford, Pittsburgh, Pa., USA VII

Preface The pineal region is an anatomic location where a wide variety of intracranial tumors occur. Germ cell tumors (GCTs) and pineal parenchymal tumors are the most frequently encountered. The frequency of pineal GCTs is higher in Asian countries, including Japan, while pineal parenchymal tumors are less frequently detected in Asia than in the United States and European countries. Emeritus Prof. Naoki Kageyama, Nagoya University School of Medicine, my teacher and one of the pioneers of GCT studies in Japan, described ectopic pinealoma as another name for suprasellar germinomas in 1961. Many original studies of intracranial GCTs by Japanese investigators have contributed to the evolution of the treatment for pineal region tumors. The current volume of Progress in Neurological Surgery takes advantage of the knowledge of Japanese experts on pineal tumors, with special emphasis on epidemiology, pathological diagnosis, and surgical, radiotherapeutic, radiosurgical and chemotherapeutic management options. We hope that this volume will enhance the knowledge of our colleagues about the various manifestations and treatment options available in the modern era of neurosurgery. Tatsuya Kobayashi, Nagoya IX